Information for patients with joint cartilage damage

Information
for patients with joint
cartilage damage
CaReS® is a new cartilage
regeneration procedure
which optimizes the
chances of healing due
to the use of the body’sown cells.
I’m so glad that CaReS®
technology exists. It has made my life
worth living again.
Martina W. / 48 years
The cartilage damage to my knee joint – a cartilage loosening of the lower
surface of the kneecap – happened quite simply when I went into a squat. One
small sideways movement and it happened. The consequences were strong pains,
restrictions when running and climbing stairs and, last but not least, the loss of
my job. Classical forms of treatment – removal of the loose cartilage particles and
patient gymnastics – brought only short term results, no lasting relief. Improvements
only occurred after I decided to undertake a cartilage cell transplantation with the
CaReS® technology, which I found out about on the Internet. I was extremely well
prepared before the operation through competent counselling, and six months after
the operation I no longer have any pain or restrictions, I have a new job and
I still have my own knee joint.
All names have been changed for legal reasons.
Step by Step
Many people suffer from inflamed and painful cartilage damage.
Danger lurks with every step: whether it’s while dancing, playing football or simply taking a walk –
the knee carries a heavy burden. As soon as the heel meets the ground, 5.5 times the body weight presses
onto this joint, at 60 kg that’s 330 kg in weight. One wrong movement can lead to cartilage damage
in the knee joint, which has limited regenerative and repair capabilities. This can lead to necessary orthopedic surgery in the future. Even the smallest injuries, hardly noticable and quickly forgotten,
can lead many years later to Arthrosis.
Eight to nine million people
Inflammation and pain released through cartilage
damage can limit the quality of life of the sufferer –
in Germany alone eight to nine million people are
affected. It is particularly serious because the cartilage degeneration process progresses continually
if it remains untreated. This degeneration can
continue until, without the sliding cartilage layer,
the joint surfaces rub directly against one another.
The consequences: Impairment to the functionality
of the joint, chronic pain and sometimes fully
fledged, irreparable Arthrosis.
Help is available
There is, as yet, no non-operative treatment to
assist in healing cartilage damage. Medication and
patient exercise can assist disorders, but are not
able to repair the damaged cartilage. For this reason
there is sometimes no other option other than
surgery. There are, however some new surgical
techniques that can repair cartilage damage and
prevent incurable Arthrosis, but these procedures
have limited application. With the introduction
of ARTHRO KINETICS CaReS® – cartilage regeneration technology – the first big step has been made
towards durable and effective regeneration of
damaged cartilage.
Healthy knee joint
Frontal view of knee (Kondylus (blue shaded area))
with intact cartilage layer
CaReS® enables durable and effective regeneration of damaged joint cartilage.
Limited Options
There are many different types of therapy – however not all of them work.
An overview of the most important developments in cartilage repair therapy.
Fiber Cartilage Formation
During the Fiber Cartilage Formation Procedure
for joint regeneration (Arthroscopy), bleeding is
provoked from the bone underneath the cartilage
damage. The blood, which fills the defect, contains
the body’s own repair cells, which form a kind of
cartilage. The problem: The quality of the developed
cartilage cannot be compared to healthy cartilage,
OATS
With a bone cartilage transplant (OATS) the defect is
repaired with new cartilage. The fresh cartilage defect
and a portion of the bone underneath is replaced by
a large healthy bone cartilage cylinder taken from a
less damaged part of the knee. The problem: cracks
develop just like when laying tiles, in which inferior
ACT
The first break-through towards the long-term
treatment of large area cartilage damage came
at the beginning of the 90’s with the Autologous
Chondrocyte Transplantation (ACT). In the first stage
Arthroscopie cartilage cells are taken from
the damaged joint, cultivated for four to six weeks
in the laboratory (in vitro) and then, in the second
stage, introduced as a liquid or mesh-like transplant,
as the repair cartilage is brittle and less flexible.
Thus, this procedure does not provide a friction-poor
surface and is unable to offer sufficient impact and
pressure resistance as it lacks the substantial
characteristics of natural cartilage.
scar tissue forms. In addition, with each bone
cylinder put into the knee, an increasingly large piece
of healthy knee surface is destroyed.
to the damaged area. The problem: to ensure that
the transplant remains where it belongs, a small
piece of bone-skin must be sewn over the defect.
However, this can loosen, as can the transplant
itself. Uncontrolled resorption and low control of the
cells reduce the chance of successful healing.
The Fiber Cartilage Formation Procedure and the bone cartilage transplant (OATS)
are qualitatively and quantitatively limited in their applications. ACT transplants can loosen themselves
or become uncontrollably resorbed.
Being able to use my knee again,
without pain or considerable restrictions,
has significantly improved the quality
of my life.
Siegfried J. / 38 years
Undertaking intensive sport activities for many years, such as playing soccer
and running marathon’s, may have lead to the dramatic cartilage damage I was
diagnosed with. The possibility of a joint prosthesis and having to abandon sports
in the foreseeable future was of course a distressing prospect, particularly as such
date drew closer. Strong pain became my daily, and soon nightly, companion, despite
a course of injections. Because of the damage, sport activities were out of the
question. It’s only thanks to CaReS® that I’ve found new hope. After many years
of continuous degradation, my condition started to improve drastically after the
operation in the middle of October 2003. By the 1st of December 2003 I could put
full pressure on the knee again – without any discomfort and above all without any
pain. It will still be some months before I run my first Marathon, but my training
has already begun.
Today, if my son asks me
to play or do some sports with him,
then I know that I can. That’s the most
important thing for me.
Klaus J. / 32 years
Three years ago, a rather dangerous skiing manoeuvre left me with cartilage
damage to the Condyle. The odyssey through orthopaedic hospitals and operating
rooms that followed was a terrible experience for me. Worse than the physical
restrictions however, was only being able to sit and watch when my small son
wanted to play. Because of this, the question of whether to have a joint prosthesis
at the age of 32, or to try cartilage cell transplantation treatment, was not hard to
answer. Today, just four months after insertion of the CaReS® transplant, it is great
to finally be once more, free of discomfort and pain, and to be able to look into
the happy eyes of my son as we stand on our boards together.
Positive Outlook
CaReS® is a completely new concept for the surgical treatment of joint cartilage defects.
With CaReS® (Cartilage Regeneration System) as with ACT, in the first stage during an ambulatory biopsy
cartilage cells are taken from the patients damaged joint. This allows liquid cells to be cultivated in a three
dimensional gel-like collagen matrix, and not – as in other procedures – in an additive stimulated two-dimensional liquid. Because the three-dimensional structure corresponds to the collagen matrix of the original biological
cell environment, cultivation without additional substances can take place in a much shorter time (10 days).
Significantly reduced operation time
Fourteen days after the ambulatory cell extraction,
the individually manufactured transplant is fitted
to the patients defective bone. The form and pressure-stable CaReS® transplant is fully adjustable in size
and thickness and can still be adapted both
in height and diameter during the operation. It is
attached to the defect with Fibrin Glue. This way
the small piece of bone-skin (as used with ACT)
is no longer neccessary, as is its time consuming
physical insertion. This means significantly less interference with the actual joint, and therefore the maximum possible protection of the joint. On average,
surgery time can be reduced from 107 to 40 minutes.
Quickly back on your feet
Recovery time is reduced by three to six months
and begins on the second day after surgery with
movement therapy. Partial pressure can be applied
after one week and after six weeks the joint can
be therapeutically fully weighted.
Damaged knee joint
Frontal view of the knee (Condyle
(blue shaded area)) focal defect in
the cartilage layer
Damaged knee joint
Frontal view of the knee
(Condyle (blue shaded area))
Punched out area prepared for
transplantation plus the transplant
adapted to the size of the defect
The CaReS® regeneration procedure generates an individual, pressure and form-stable transplant
in only 14 days, which can be used in a substantially shorter time than ever before. Light pressure on the
operated joint can take place after only one week and after six weeks the joint can be therapeutically fully
weighted.
New Technology
Progress in cell cultivation clearly makes CaReS® superior to other cartilage substitution methods.
CaReS® stands for a new, minimum invasive
concept for the surgical treatment of large area
damage to the knee joint. With CaReS® technology
ARTHRO KINETICS has succeeded in overcoming
the problems of cartilage transplantation experienced
in traditional methods of cell cultivation. In vitro produced cells - as used with ACT – suffer substantial
characteristic changes during the 2D cultivation process. Unlike with CaReS®, where a three-dimensional, collagen based gel matrix is used for the first
time as a carrier medium for cell production. Directly
after their removal from the patient’s cartilage, the
Clinical study
Treatment studies at the RWTH Aachen University of
Technology and clinical studies at more than 70
notable German and European hospitals confirm:
The human joint cartilage replacement CaReS® is
clearly superior
cells are embedded in the 3D-Matrix. The cells are
not affected in their structure or characteristics and
multiply and synthesize in a substantially shorter time
into sturdy cartilage tissue. CaReS® technology is
applicable for defect sizes of up to 10 cm2. The surrounding cartilage structure is completely preserved
during the whole regeneration process and full joint
mobility is returned on a long-term basis.
to other cartilage substitution methods regarding
biomechanical stability, convalescence time, surgery
duration and trauma. By March 2006 more than
750 patients had already been successfully treated
with CaReS®.
Transplanted knee joint
Frontal view of the knee (Condyle (blue shaded area))
®
with CaReS transplant filled cartilage layer
A CaReS® transplant is superior in availability, functionality, operability and long-term healing success
to other established cartilage substitution methods.
CaReS® appeared to me, to be
the safest and most promising treatment
Peter S. / 46 years
The consequences of an old injury to my left knee became particularly apparent
when I began working in my vineyard: The broken cartilage blocked the joint
repeatedly, to the extent that I could hardly move my knee anymore. The sobering
diagnosis: a defect to the interior of my left knee and deterioration in the rest of the
remaining area which would collapse in less than two years. As an alternative to a
prosthesis, my physician told me about CaReS®, which in my eyes, seemed to be the
safest and most promising treatment. My opinion was confirmed some months later
after the successful operation which, due to the small size of the transplant, was able
to take place on an out-patient basis. I became my doctors first CaReS ® patient and
after only three to four weeks, I could fully bend my knee again without any problems. Eight weeks later I was able to resume work in my vineyard, firm on my
two legs, with just as much knee mobility as I had before the injury.
New Horizons
CaReS® advantages and a look ahead.
CaReS® has numerous advantages for the patient. Besides the complete regeneration
of the damaged joint cartilage other advantages include:
– Shorter surgery time
– Faster due to 3D cell cultivation
– High quality transplant
– Greater possible absorption of the surrounding material
– Less operational trauma
– Less and smaller joint swelling
– Shorter rehabilitation time
– Optimal long-term healing chances
For a carefree future
With its vision of supplying patients with
regenerated natural joint mobility ARTHRO KINETICS
is further developing CaReS® technology for use in
ankle, shoulder and smaller joints. First results for
meniscus or intervertebral disk replacement will be
available for clinical studies and will be manufactured
on this basis.
Regenerated knee joint
Frontal view of the knee (Condyle (blue shaded area))
®
with CaReS transplant filled cartilage layer
ARTHRO KINETICS is working on the advancement of CaReS® technology for other operational areas
of orthopedic surgery.
Questions and Answers
Everything you ever wanted to know about CaReS®.
You’ll find a detailed and constantly updated FAQ list on the internet at: www.arthro-kinetics.com.
Q What diagnosis will call for the use of CaReS® technology.
A Indications for the use of a CaReS® transplant are focal damages
(2.5 to 10 cm2, degrees of III/IV according to Outerbridge) to the
Condyle (shin-bone to knee), to the Tibia (thigh bone to knee),
retro-patellar as well as in the ankle joint.
Q For which age groups is CaReS® applicable?
A We recommend the use of CaReS® treatment for patients whose
bones are fully matured and who are under 55 years old.
Q Under which circumstances can’t CaReS® be used?
A At present CaReS® cannot be used with joint-rigidity, Arthritis
fibrosis, ligament and meniscus injury, unaligned leg joint positions,
inflammatory problems, infections, Osteo-arthritus, metabolic
illnesses and adiposis.
Q How does the CaReS® procedure work?
A The body’s own autologous cartilage cells are surgically removed
by Arthroscopie – and combined witha gel-like transplant is individually developed as a carrier matrix from a human-protein-like collagen type I. It is adjustable both in height and diameter, size and
thickness, even during the attachment procedure. The transplant is
glued into the defective area – two days after the surgery the joint
is movable and after approximately three months capable of supporting full weight.
Q How does CaReS® differs from other cartilage transplant methods?
A CaReS® stands for preventative surgery, shorter recovery and
surgery times, for comparatively little costs.
Q How long has CaReS® been in operation?
A Clinically the implantation of CaReS® technology has been used
since November 2002 in the context of surgical observations in
RWTH Aachen, and since the beginning of 2003 in a clinical study
at more than 70 notable German and European hospitals.
By March 2006 more than 750 patients had been successfully
treated with CaReS®.
Q Is one extraction of cartilage tissue sufficient or is it necessary
to repeat the procedure?
A One extraction of cartilage tissue is sufficient and only a small
quantity of cartilage cells is required, which speeds up the
entire procedure.
Q How will my body react to the implant?
A Since the implant consists of the body’s-own cells, it suffers from
no rejection reactions. Side effects resulting from the transplant
are unknown.
Q How long after surgery does it take until my knee can support
a full weight?
A Rehabilitation time is around three to six months and begins the
second day after surgery with movement therapy. Partial weight
can be supported after one week and after six weeks, from
a therapeutic viewpoint, the joint can support heavy pressure.
After 6 months the joint should be able to sustain full weight.
Q Will I have to wait a long time after surgery to use my knee?
A Not with regard to possible pain or problems. From a therapeutic
viewpoint you are able to put pressure on your knees after six
weeks. However, recovery is an individual process and therefore
depends strongly on the individual situation. In the interest of the
long-term success of the treatment we recommend that you
reduce putting the cartilage under extreme strain.
Q Who offers CaReS® treatment?
A We would be happy to personaly help with your query.
Please contact us. You can also find first information on our
website: www.arthro-kinetics.com.
Q What does the CaReS® treatment cost?
A The cost of a CaReS® transplant is approximately 10,000 EUR.
Q Will my health insurance company carry the cost?
A Although they are legally obligated to take over the full cost,
many health insurance companies today unfortunately only cover
about 25 per cent of the cost of a CaReS® transplant.
Costs are also often assessed on an individual basis.
Q Who will help if the health insurance company refuses to cover
the medical fees?
A In this case please contact us. We will do everything we can
to help you, and your physician, convince your health insurance
company of the necessity for your treatment.
ARTHRO KINETICS PLC (Registered Office)
123 Deansgate Manchester M3 2BU UK [email protected]
ARTHRO KINETICS PLC
(Head Office)
Schelztorstraße 54–56
73728 Esslingen / Germany
T +49 (0)711 30511076
F +49 (0)711 30511086
ARTHRO KINETICS
BIOTECHNOLOGY GMBH
Magnesitstrasse 1
3500 Krems an der Donau / Austria
T +43 (0)2732 7695425
F +43 (0)2732 7695450
www.arthro-kinetics.com
ARTHRO KINETICS PTY LTD
Suite 1, 36 Bayswater Road
Potts Point, Sydney
NSW 2011 / Australia
T +61 (0)2 9358 3244
F +61 (0)2 9358 3255
ARTHRO KINETICS INC
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Boston
MA 02109 / USA
T +1 617 9736462
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